Inspection on 16/03/06 for Windsor Road Mental Nursing Home

This inspection was carried out on 16th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Windsor Road Mental Nursing Home 13/08/09

Windsor Road Mental Nursing Home 23/05/07

Windsor Road Mental Nursing Home 17/02/05

Windsor Road Mental Nursing Home 22/11/04

Windsor Road Mental Nursing Home 27/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Windsor Road Mental Nursing Home 30 Windsor Road Ansdell Lytham St Annes Lancashire FY8 1AH Lead Inspector Denise Upton Unannounced Inspection 16th March 2006 10:00 Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Windsor Road Mental Nursing Home Address 30 Windsor Road Ansdell Lytham St Annes Lancashire FY8 1AH 01253 731424 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01253 731114 Richmond Fellowship Mrs Kirsten Sharrock Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 individuals with severe and enduring mental health needs not liable to be detained under the Mental Health Act 1983 - 18 years 27th June 2005 Date of last inspection Brief Description of the Service: Windsor Road is a care home with nursing registered to accommodate up to ten young adults living with an enduring mental illness. The home is a purpose built establishment with accommodation on ground and first floor, a passenger lift is available. All accommodation is offered in single rooms with two rooms offering bed-sit type accommodation including kitchen areas. All rooms are en-suite with bathing and shower facilities. Additional bathing/shower facilities are provided if assistance is required. There are two lounge areas, one activity room plus a conservatory leading to a well-maintained rear garden. The home is situated in Ansdell and is within walking distance of shops, churches, public houses and the beach. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a midweek day and lasted a period of six and a half hours. The inspector spoke with the registered manager, deputy manager, cook, and two members of the care staff team who were on duty at the time of inspection. In addition, two residents who were living at the home were spoken with individually and general informal discussion also took place with several other residents during the course of the day. A number of records and policies and procedures were examined and a partial tour of the building took place that included communal areas of the home, some bedroom accommodation and kitchen and laundry facilities. A substantial number of the core standards regarding Care Homes for Adults had been assessed at the last inspection that took place in June 2005. The outstanding twelve core standards were assessed at this inspection along with a reassessment of the requirement identified in the last inspection report. In addition, requirements and recommendations identified following a subsequent Commission For Social Care Inspection, Pharmacist Inspection were also reassessed. During the course of the inspection, six residents also completed The Commission For Social Care Inspection service user comment cards. This provided further information on how residents felt that Windsor Road Care Home was meeting their needs and requirements while resident at the home. As not all of the core standards identified in the National Minimum Standards Care Homes For Younger Adults were assessed at this inspection, it is strongly recommended that this report be read together with the last inspection report to get a full picture of how the service is meeting the needs of the residents living at the home. What the service does well: This is a care home where residents are well looked after and staff work hard to provide a high quality service. The staff team work well together, have a good relationship with people who live at the home and show a good understanding of the needs and wants and wishes of each individual resident. Residents spoken with were comfortable living at the home and got on well with the staff team. Residents are encouraged to have their say and are involved in making joint decisions about the home. One resident stated that she ‘enjoyed living at the home’ and also ‘the support of the staff’. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 6 Routines within the home are flexible so that the people who live there can enjoy the lifestyle of their choice. Residents are encouraged to make choices and decisions for themselves and to take part in social activities in the local community or to attend educational college courses. One resident was keen to talk about her college course and how she was enjoying this opportunity. Staff training is given high priority at Windsor Road to make sure that the staff group have the knowledge and skills to meet resident’s social and health care needs on an individual basis. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The pre admission assessment process to determine if a prospective resident’s current strengths and needs could be met at the home is thorough to ensure that requirements can be addressed. EVIDENCE: Although no new residents have taken up residence at the home since the last inspection, it was clearly evident that new residents are only admitted to Windsor Road Care Home following the outcome of a full assessment of current strengths and needs including multi disciplinary assessments. The pre admission procedure adopted is structured and detailed to ensure that all new admissions are appropriate for the home and that the prospective resident’s strengths, needs and wants and wishes can be addressed. This collated information, including the outcome of the home’s independent pre admission assessment, forms the basis of the initial care plan that is developed in consultation with the individual resident. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 The home regularly reviews individual risk assessments to make sure the information remains up to date and does not unduly restrict residents from determining their own lifestyle. EVIDENCE: All residents at Windsor Road are encouraged to make decisions for themselves and determine their individual lifestyle whilst taking into account the outcome of individual risk assessments. Staff are provided with specific training about supporting residents to make informed decisions and to take positive risks in their daily lives. A resident individually spoken with confirmed that she is supported to make day-to-day decisions regarding her daily routines and lifestyle and is provided with information and assistance in order to make informed choice. Details of local advocacy services are provided and a local advocacy group has been invited to visit the home and speak with residents. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 10 Wherever possible, residents are encouraged to manage their own financial affairs independently. However support is provided on an individual basis to a number of residents that was determined as part of the initial assessment process and the need for continued support is kept under constant review. The multi disciplinary pre admission information identifies risk and any risk management strategies that had been agreed prior to admission to the home. In consultation with the resident, the outcome of risk assessments, including subsequent ‘in house’ risk assessments are reviewed on a regular basis to make sure the information remains current. The outcome of risk assessments are recorded and incorporated as appropriate, in the individual care plan. Residents are routinely provided with relevant information on how to maximise their own personal safety in order to avoid limiting the resident’s choice. Through observation of a policy document, it was confirmed there are formal procedures to follow should a service user not return to the home when expected. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 16 & 17 Links with the community are good and support and enrich service users social, work and educational opportunities. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choice. EVIDENCE: Family and friends are encouraged to visit the home at any time of the resident’s choice. Likewise, residents are enabled and encouraged to maintain existing family and friendship links in the community either independently or with the support of staff or alternatively to develop new friendships. A resident spoken with stated that she enjoyed her family visiting her at Windsor Road but that she also enjoyed going out and visiting friends and family in her local area. The vast majority of residents at Windsor Road are physically able with independent mobility. Bathrooms and individual bedroom accommodation is fitted with a locking mechanism with the residents retaining the key to their Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 12 individual bedroom accommodation. Mail is distributed directly to service users as it arrives at the home and the preferred term of address of all prospective residents is identified prior to admission and always respected. It was clear that the relationship between staff and residents is relaxed and comfortable with residents dictating whether to participate in an activity or enjoy the privacy of their individual bedroom accommodation. Resident’s health is promoted by ensuring a nutritious, varied and balanced diet that is designed round the known likes and dislikes of residents accommodated. Residents are encouraged to become involved in menu planning that is regularly reviewed to reflect seasonal variations and resident choices. All residents spoken with were positive in their comments with regard to the meals served and in order to promote independence, a cooking club has recently been introduced where residents are encouraged to help prepare and cook appropriate foods. These views were further reinforced through the Commission For Social Care Inspection comment cards that a number of residents completed during the course of the inspection. The inspector enjoyed a midday meal with residents and staff in the dining room. A choice of meal was served that was well cooked and attractively presented and residents spoken with later, stated that they had enjoyed the meal ‘very much’. Diets in respect of cultural, religious or medical need can be accommodated that would be identified during the assessment process. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & Standard 20 was reassessed in part. The staff group have a good understanding of resident’s support needs. This is evident from the positive relationships that have been formed between the staff and residents. The home has a structured process in respect of medication and improvements have been noted that offers greater protection for residents accommodated. EVIDENCE: Although the majority of residents are independent in respect of personal care skills, when support is required this is offered in such a way as to respect the privacy, dignity and independence of the individual resident. Residents elect when they choose to get up or go to bed and the individual clothes and hairstyle they wear that reflects their personality. The home maintains close links with psychiatric and general medical services in order to maintain the optimum mental and physical health of residents accommodated. Since the last inspection, the Commission For Social Care Inspection Pharmacist Inspector visited the home to provide advice and guidance in respect of medication issues. At this inspection various requirements and recommendations were identified and the management team has made good Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 14 progress in addressing a number of the items raised. However a small number of recommendations remain outstanding and have yet to be addressed. Improvements have been made to the way hand-written drug administration records are recorded that is now countersigned by a second member of staff. In addition as identified in the last inspection report, the control drugs cupboard is now appropriately bolted to the wall and systems for the recording and storage of medication awaiting disposal has been significantly improved. As previously recommended, residents are now asked to sign a declaration of wishes for medication handling and the recording of medication administered to residents who are ‘on leave’ has been improved to enable a satisfactory audit trail to be established. The signed prescription is now evidenced by the home prior to the pharmacist dispensing the medication and the MAR sheet is now used for recording the receipt of medication. However the recommendation has yet to be implemented in respect of writing the date on the medication packaging upon opening to further improve the audit trail. It was also noted that although generally well recorded, occasional ‘gaps’ were still evident on the Medication Administration Record (MAR) sheet. All staff should be reminded that the medication administration record must be signed immediately after the medication has been administered and staff should immediately question if a ‘gap’ is noted on the medication administration record. The use of the key code system to explain the none-administration of medication has improved however occasional “as directed” instructions were still evident on the MAR sheets and as recommended in the last inspection report, these should be clarified and repeat prescriptions amended for the next supply. Staff should write the correct instructions on the MAR and sign and date the record also indicating how the correct dosage instructions were obtained i.e. phone call to GP. It is understood that the management team are in the process of changing the pharmacist who supplies medication to the home and adopting a monitored dosage system for the administration of medication. The new supplier has already provided some training to the staff team in respect of the system to be introduced and also material for on-going training. In addition, the home’s medication policy and procedures are in the process of review and update in order to reflect the new system. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Staff have a good knowledge and understanding of Adult Abuse issues that helps to protect residents from abuse. EVIDENCE: Policies and procedures are in place to safeguard service users from any form of abuse or exploitation. The home has a copy of the Department of Health Guidance `No Secrets In Lancashire’ document and staff are provided with adult abuse training during the mandatory induction training programme and National Vocational Qualification training. The organisation’s corporate Adult Abuse Policy is available in the home along with a whistle blowing policy. However, as a result of a recent incident, the adult abuse policy that is specific to the requirements of home is currently under review to ensure that all staff are aware of and follow the local protocols. Whilst it is acknowledged that all staff have previously received training in respect of adult abuse, it is recommended that when the review and amendment of the existing policy and procedures is complete, staff receive further training to ensure that local protocols are understood. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above seven standards were assessed at this inspection. EVIDENCE: None of the above seven standards were assessed at this inspection. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: From observation it was evident that there was a good rapport between staff and residents that help people who use the service feel safe, comfortable and well supported. Discussion with residents confirmed that they felt well cared for and that staff responded to wants and needs on an individual basis. One resident stated that the best thing for her about living at the home was ‘the support of the staff’ to enable her to enjoy the lifestyle of her choice that included attending College and accessing local community facilities. Staff training within the organisation is given high priority. All staff are required to attend a variety of mandatory training topics. There is a designated training budget and a training needs analysis is undertaken annually. Permanent members of staff undertake the twelve-week corporate inductiontraining programme that is compliant with the nationally recognised ‘Skills For Care’ induction training standards. This ensures that staff have the basic skills to provide a good quality service. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 18 Individual discussion with staff confirmed that staff felt very positive about the training provided with one member of staff stating that ‘I have enjoyed the training and would like to undertake some further training, the training is very good’ Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 Standard 38 was reassessed in part. Systems are in place to ensure as far as possible the health and safety of service users, staff and visitors. EVIDENCE: Since the last inspection, the registered manager has recommenced full time day-to-day management responsibility within the home. However in order to strengthen the management team, it is understood that a further person is to be appointed in order to undertake a clinical lead. Formal and informal systems are in place to ensure residents are enabled to make their views are known that includes satisfaction questionnaires, participating in the local tenant involvement group, active involvement in the recruitment of staff and informal daily dialogue with staff. This allows residents to have a say into how the home is run. Residents can also influence change through fortnightly ‘resident meetings’. In addition, organisational systems are in place for service user consultation at a national level and recently residents Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 20 have being involved in designing the new home’s brochure that incorporates resident’s comments about living at the home. The organisation has achieved the ‘Investor In People’ award that provides an external quality monitoring system on how the organisation is achieving aims for users of the service. A written statement of the policy, organisation and arrangements for maintaining safe working practices was evidenced along with a variety of further policies and procedures in respect of health and safety issues. Systems are in place for a management environmental ‘audit’ that takes place on a regular routine basis. All staff undertake a variety of mandatory health and safety training. Risk assessments in respect of the physical environment are carried out so that the risk of potential accidents is reduced. Staff spoken with confirmed that risk assessments are kept under constant review and amended as required that was also evidenced through documentation. Staff are required to complete a six weekly questionnaire regarding a variety of health and safety issues to ensure standards are maintained and staff have the knowledge and skills to maintain safe working practices. Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 X X 3 3 X X 3 X Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out t he actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA20 Good Practice Recommendations All medication packaging should be dated upon opening. Medication administration records should be signed immediately after the medication has been administered and staff should immediately question if there is a ‘gap’ in the medication administration record. “As directed” instructions on the MAR sheet should be clarified. Staff should then write the correct instructions on the MAR sheet and sign and date the record. All staff should receive training in respect of the amended adult abuse policy and procedures. 3 4 YA20 YA23 Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Windsor Road Mental Nursing Home DS0000006092.V279360.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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